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NOTE ON THE OPERATIVE TREATMENT OF ECTROPION.
98 1898, a small, clearly-defined, and sharply-depressed scar marked the site of the sinus. As to the treatment adopted it should be said that the general condition of the woman was at no time such as to give cause for alarm nor was the pain extremely severe, and so the surgical rule for promptly evacuating an abscess in the abdominal wall was ignored in favour of tentative treatment, the wisdom of this being finally vindicated by the result. All through the illness vomiting only occurred once or twice and the formation of the abscess was not accompanied by rigors ; the absence of both of these symptoms in cases of "perigastric abscess" (which cases, it appears, have almost invariably a fatal ending) is remarked upon under that heading in Quain’s Dictionary of Medicine. There was never any symptom of threatened intestinal obstruction. The sinus appeared throughout to be an ordinary sinus-that is to say, there was no evidence of its being a gastric or intestinal fistula. I have mentioned the small size of the external opening when first seen; an ordinary lead pencil would have been a close fit and so the possibility of the patient having inserted the fabric after the abscess had burst was quite negatived. And now the question arises, From which part of the alimentary tract did the foreign body ulcerate its way ?7 Without going into the anatomical and pathological pros and cons I do not think there can be much doubt that it was from the stomach. Dobcross, Saddleworth.
having had the case photographed also when the deformity existed, since a comparison of its condition before and after the operation would have had still more intereat at not
for the reader.
The failure of Snellen’s method in this case was, I believe,. fact that when that method was devised the rule and asepsis the eaceptionm therefore the suture, by causing a septic tract, produced cicatricial bands which contracted on healing and thus cured the condition, but now when suppuration is almost
largely due to the suppuration was
NOTE ON THE OPERATIVE TREATMENT OF ECTROPION. BY H. CARTER THE
MACTIER, B.A., M.B., B.CH. DUB.
of non-cicatricial ectropion are sufficiently also are the methods of treating this deforwell known, mity by operation-viz., Snellen’s suture, tarsorrhaphy, and Kiihnt’s operation-and they need not be discussed here. I hall therefore proceed to describe the details of what I believe to be a new method of operation. In September, 1897, while I was doing duty for the visiting surgeon to the Wolverhampton Eye Infirmary a man was placed in my charge who was suffering from a senile ectropion of the left side, the palpebral conjunctiva overhanging the skin for about two millimetres. This condition had arisen in the previous April. He had been operated upon for the relief of the deformity on August 14th, Snellen’s suture being the method employed, but on the removal of the suture the lid reverted to its former faulty position and it was therefore necessary to adopt some other procedure. On Sept. 10th the patient was ansesthetised with ether and I performed the following operation. A Jager’s bone plate lid-holder being placed in the left conjunctival sac and being held in position by an assistant I made a curved incision with the concavity upwards parallel to and about two centimetres below the free border of the lid, the incision being about three centimetres in length. I then carefully dissected in an upward direction through, the tissues, keeping posterior to the tarsal cartilage, until the conjunctival sac was exposed and freed from attachments except at its junction with the edge of the skin at the margin of the lid. The lid-holder greatly facilitated this part of the procedure. All haemorrhage being stopped with pressure a fine silk suture was passed after the method of Snellen, the free ends being brought out just below the lower margin of the skin wound, then a double-pointed horsehair suture was passed from the bottom of the conjunctival sac and the free ends were brought out below those of the silk suture. Both 8utures were then drawn tight and tied, the tension exerted being just sufficient to produce a slight amount of entropion and the hair suture holding the bottom of the freed conjunctival sac at the level of the wound in the skin, the last wound being then sutured with a few points of horsehair. Iodoform powder was dusted on and a Gamgee pad smeared with iodoform ointment (15 grains of iodoform to one ounce of vaseline) placed over both the eye and the skin wound, the whole being secured with a roller bandage. The wound healed by first intention and I removed the sutures on the fifth day, the result being excellent, as the accompanying figure, copied from a photograph which was taken a month after the operation, shows. I must express my regret causes
as
of the past the lid simply reverts to its faulty when the suture is withdrawn. In the operation which I have described above the conjunctival sac and therefore the palpebral conjunctiva are pulled downwards and by healing in at a lower level draw the edge of the lid upwards and inwards thus producing a cure. The advantages I claim for this method are (1) that it is applicable to cases where Snellen’s method fails, (2) that the scar left by the incision in the skin being in a natural fold is not so apparent as that of Kiihnt which is vertical, and (3) that the tarsal cartilage does not require to be cut and the difficulty of bringing the two sides of a V-shaped incision together-a seemingly simple but practically very difficult matter-when doing Kuhnt’s operation is therefore avoided.
thing position a
Wolverhampton.
Clinical Notes : MEDICAL, SURGICAL, OBSTETRICAL, AND THERAPEUTICAL. NOTE ON OCULAR PARALYSIS FOLLOWING HERPES FACIALIS. BY ALFRED RUTTER, M.B., C.M. EDIN. JUDGING from the literature on the subject danger from eye complications in cases of herpes zoster ophthalmicus involving the supra-orbital branch only of the first division of the fifth nerve would appear to be too infrequent to call for serious apprehensions. This statement would, perhaps, no!i apply in those examples of herpes in which the eruption occurs on the cutaneous area supplied by the nasal branch. Induced by these considerations I wish to place on record the details of a case now under my care in which ocular
paralysis has become the most prominent and (to the patient) most troublesome, if not, in view of other possible contintingencies, the most serious symptom. On Jan.
3rd, 1898, I
30 years, for
a
asked to attend a man, aged attack of erysipelas commencing
was
supposed
having had the case photographed also when the deformity existed, since a comparison of its condition before and after the operation would have had still more intereat at not
for the reader.
The failure of Snellen’s method in this case was, I believe,. fact that when that method was devised the rule and asepsis the eaceptionm therefore the suture, by causing a septic tract, produced cicatricial bands which contracted on healing and thus cured the condition, but now when suppuration is almost
largely due to the suppuration was
NOTE ON THE OPERATIVE TREATMENT OF ECTROPION. BY H. CARTER THE
MACTIER, B.A., M.B., B.CH. DUB.
of non-cicatricial ectropion are sufficiently also are the methods of treating this deforwell known, mity by operation-viz., Snellen’s suture, tarsorrhaphy, and Kiihnt’s operation-and they need not be discussed here. I hall therefore proceed to describe the details of what I believe to be a new method of operation. In September, 1897, while I was doing duty for the visiting surgeon to the Wolverhampton Eye Infirmary a man was placed in my charge who was suffering from a senile ectropion of the left side, the palpebral conjunctiva overhanging the skin for about two millimetres. This condition had arisen in the previous April. He had been operated upon for the relief of the deformity on August 14th, Snellen’s suture being the method employed, but on the removal of the suture the lid reverted to its former faulty position and it was therefore necessary to adopt some other procedure. On Sept. 10th the patient was ansesthetised with ether and I performed the following operation. A Jager’s bone plate lid-holder being placed in the left conjunctival sac and being held in position by an assistant I made a curved incision with the concavity upwards parallel to and about two centimetres below the free border of the lid, the incision being about three centimetres in length. I then carefully dissected in an upward direction through, the tissues, keeping posterior to the tarsal cartilage, until the conjunctival sac was exposed and freed from attachments except at its junction with the edge of the skin at the margin of the lid. The lid-holder greatly facilitated this part of the procedure. All haemorrhage being stopped with pressure a fine silk suture was passed after the method of Snellen, the free ends being brought out just below the lower margin of the skin wound, then a double-pointed horsehair suture was passed from the bottom of the conjunctival sac and the free ends were brought out below those of the silk suture. Both 8utures were then drawn tight and tied, the tension exerted being just sufficient to produce a slight amount of entropion and the hair suture holding the bottom of the freed conjunctival sac at the level of the wound in the skin, the last wound being then sutured with a few points of horsehair. Iodoform powder was dusted on and a Gamgee pad smeared with iodoform ointment (15 grains of iodoform to one ounce of vaseline) placed over both the eye and the skin wound, the whole being secured with a roller bandage. The wound healed by first intention and I removed the sutures on the fifth day, the result being excellent, as the accompanying figure, copied from a photograph which was taken a month after the operation, shows. I must express my regret causes
as
of the past the lid simply reverts to its faulty when the suture is withdrawn. In the operation which I have described above the conjunctival sac and therefore the palpebral conjunctiva are pulled downwards and by healing in at a lower level draw the edge of the lid upwards and inwards thus producing a cure. The advantages I claim for this method are (1) that it is applicable to cases where Snellen’s method fails, (2) that the scar left by the incision in the skin being in a natural fold is not so apparent as that of Kiihnt which is vertical, and (3) that the tarsal cartilage does not require to be cut and the difficulty of bringing the two sides of a V-shaped incision together-a seemingly simple but practically very difficult matter-when doing Kuhnt’s operation is therefore avoided.
thing position a
Wolverhampton.
Clinical Notes : MEDICAL, SURGICAL, OBSTETRICAL, AND THERAPEUTICAL. NOTE ON OCULAR PARALYSIS FOLLOWING HERPES FACIALIS. BY ALFRED RUTTER, M.B., C.M. EDIN. JUDGING from the literature on the subject danger from eye complications in cases of herpes zoster ophthalmicus involving the supra-orbital branch only of the first division of the fifth nerve would appear to be too infrequent to call for serious apprehensions. This statement would, perhaps, no!i apply in those examples of herpes in which the eruption occurs on the cutaneous area supplied by the nasal branch. Induced by these considerations I wish to place on record the details of a case now under my care in which ocular
paralysis has become the most prominent and (to the patient) most troublesome, if not, in view of other possible contintingencies, the most serious symptom. On Jan.
3rd, 1898, I
30 years, for
a
asked to attend a man, aged attack of erysipelas commencing
was
supposed